Why the study?
The study aimed to determine whether higher blood sugar, even within the prediabetes range, affects coronary lesion characteristics in patients with symptomatic coronary artery disease.
Does prediabetes or diabetes affect coronary lesion length and plaque composition on CCTA compared to euglycemia in patients with symptomatic coronary artery disease?
Cross-Sectional (n=184)
Does prediabetes or diabetes affect coronary lesion length and plaque composition on CCTA compared to euglycemia in patients with symptomatic coronary artery disease?
Even prediabetic glycemic levels are associated with longer coronary lesions and a higher prevalence of vulnerable, predominantly non-calcified plaques on CCTA, similar to overt diabetes.
Answers are grounded in this paper and cite their sources.
Prediabetes may associate with adverse coronary plaque features in symptomatic CAD; leaves open whether glycemic control modifies progression or events.
Purpose This study aims to determine if higher blood sugar, even within the prediabetes range, affects coronary lesion characteristics. Material and methods Symptomatic patients with confirmed CAD on CCTA were stratified into three different groups based on their glycated-hemoglobin (HbA1c) levels: 1) Euglycemia, HbA1c below 5.7% (HbA1c < 39 mmol/mol) 2) Prediabetes, HbA1c-levels between 5.7% and 6.4% (HbA1c = 39-46 mmol/mol) 3) Diabetes, HbA1c-levels ≥6.5% (HbA1c ≥ 48 mmol/mol). A plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software was performed and findings between the three different groups were compared. Results Overall 184 patients and 247 coronary lesions were analyzed. Coronary lesion length was significantly greater in prediabetic [(29.5 mm (12.7–50-4) versus 24.8 mm (11.4–51.1), p = 0.025)] and diabetic individuals [(30.1 mm (16.7–50.2) versus 24.8 mm (11.4–51.1), p = 0.005)] compared to those with normal HbA1c levels. In terms of plaque composition and volume, diabetic individuals demonstrated a significantly higher amount of total lipid-rich plaque volume [(62.5 mm 3 (38.1–93.7) versus 41.9 mm 3 (22.4–66.7), p < 0.001] and total fibrotic plaque volume [55.7 mm 3 (37.1–92.2) versus 29.3 mm 3 (16.9–61.2), p = 0.004] compared to euglycemic patients. In multivariable adjusted logistic regression, there was a significant association between both prediabetes and diabetes and predominantly non-calcified plaques (odds ratio [OR] 2.124 [95% CI (1.016–4.437), p = 0.045 and OR 2.505 (1.029–6.098), p = 0.043]. Conclusion Poor glycemic status is associated with a higher prevalence of predominantly noncalcified plaques in symptomatic individuals. When compared to euglycemic individuals, prediabetic individuals demonstrate an extended coronary lesion length similar to diabetics. These factors may play a role in the poorer clinical outcomes even observed in patients with borderline diabetes.
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Adolf et al. (2026) conducted a cross-sectional in Symptomatic coronary artery disease (n=184). Prediabetes (HbA1c 5.7%-6.4%) and Diabetes (HbA1c ≥6.5%) vs. Euglycemia (HbA1c <5.7% / <39 mmol/mol) was evaluated on Predominantly non-calcified coronary plaques on CCTA (OR 2.124, 95% CI 1.016-4.437, p=0.045).
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